lcole7465
Expert
Any input on this would be great....
My provider performed a Lumbar RFA on L4 and dorsal ramus of L5... which should be 64635 since it is one level. The insurance company denied 64635 and approved 64636. The person that does our authorizations explanation is below, the insurance is Anthem Medicare Advantage:
"This was a nightmare with the insurance company. When you ask for authorization, you have to give levels per CPT code. 64635 was L3-4 and 64636 was L4-5. Insurance denied 64635, L3-4, because only one MBB was done on this level because they denied the second MBB at this level. When I explained this to them, they did not care. They approved 64636, L4-5, because 2 MBB’s were done at this level. It is the strangest thing I have ever heard of."
I'm not sure what to do in this situation. I know 64636 is an add-on code and shouldn't be/cannot be billed by itself.
My provider performed a Lumbar RFA on L4 and dorsal ramus of L5... which should be 64635 since it is one level. The insurance company denied 64635 and approved 64636. The person that does our authorizations explanation is below, the insurance is Anthem Medicare Advantage:
"This was a nightmare with the insurance company. When you ask for authorization, you have to give levels per CPT code. 64635 was L3-4 and 64636 was L4-5. Insurance denied 64635, L3-4, because only one MBB was done on this level because they denied the second MBB at this level. When I explained this to them, they did not care. They approved 64636, L4-5, because 2 MBB’s were done at this level. It is the strangest thing I have ever heard of."
I'm not sure what to do in this situation. I know 64636 is an add-on code and shouldn't be/cannot be billed by itself.